Acting on command hallucinations: A cognitive approach

This study explores factors influencing compliance with command hallucinations. The most widely acknowledged factor is the content of the command. Three categories of command content were found to be discrete in terms of compliance: 'innocuous' commands, 'severe' commands and commands to self-harm. This study takes a cognitive approach and highlights the importance of the beliefs individuals hold about their voices. Beliefs appear to be important in determining whether or not individuals comply with commands and the affect generated. A belief that the voice is benevolent was associated with compliance with both innocuous and severe commands. In addition, participants who believed they retained subjective control over their voices were less likely to comply with all types of command. Furthermore, qualitative evidence suggested that several other beliefs may influence compliance with command hallucinations such as beliefs about the effects of transgression, beliefs about the power and authority of the commander, beliefs about the social acceptability of the action (which may be closely correlated or synonymous with severity) and its effectiveness in achieving a valued goal. Further research is necessary to investigate the importance of these beliefs and their interrelationships more fully.